Credentialing in Hospitals and ASCs
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Credentialing may be based in part on CME credits obtained over the past 1-2 years so it is
prudent to maintain a presence in that arena.
Finally, credentialing may be intertwined with the exclusive contracts of another entity such as
anesthesiology. Some anesthesiology groups contend their contract gives them the rights to all
anesthesia based services. However, if pain management/pain medicine is not explicitly
specified in their contract, it may be possible to obtain privileges and credentials without their
involvement. But often medical staff offices are not astute enough to decipher such nuances and
may ask you to apply to the anesthesiology group before the medical staff office can send you
an application. If this is the case, it may serve you well to simply call the president of the group
and discuss the issue, making it clear you intend to perform only interventional pain procedures
or if you are establishing a pain center that you will be engaging in medication management,
functional restoration, and interventional pain. Generally anesthesiology departments cannot
exclude other pain physicians from practicing pain management but need assurances that you
are not planning to compete with them for OR anesthesia cases. This assurance can be
achieved by a simple letter to the president of the hospital, president of the anesthesia group,
and the medical staff office that your intentions are solely to practice pain medicine and that you
will not be engaging in the delivery of anesthesia other than sedation for your own patients.
Radiology departments may also have exclusive clauses for radiological services. Usually this
group's exclusive contract is only problematic if you are engaging in the use of the cardiovascular
lab, MRI, or CT for interventional procedures when that group is already performing the
same procedures. Typically there are no issues invoked by an interventional pain physician
performing cases in the OR under C-arm since this is out of their geographical purview.
It should be noted that privileges and credentialing are linked but are not the same process.
Core privileges are usually requested on the initial application (including discography, injections,
RF, cryo, etc) while advanced privileges may need further documentation of training. Once all
documentation requested is submitted, the process of credentialing for hospitals or ASCs may
take 2-4 months depending on the rapidity of verification of documentation, NPDB query time,
when the credentials committee meets and then when the medical executive committee meets
since the credentials must be serially approved in that order. Often the hospital board must then
approve the application of the physician to the medical staff. It is useful to call the medical staff
office every 2-3 weeks or so to check on progress and whether there are any missing
documents. At times, a reference letter from a colleague is not received in a timely fashion
which may require you to directly contact the person about such letter. Medical staff offices will
not always notify you that there are missing documents or letters until many months later, so it
pays to be quite proactive in this endeavor.